• Home
  • Store
    • Newsletter Subscriptions
    • Multimedia Subscriptions
    • Books
    • eBooks
    • ABPN SA Courses
  • CME Center
  • Multimedia
    • Podcast
    • Webinars
    • Blog
  • Newsletters
    • General Psychiatry
    • Child Psychiatry
    • Addiction Treatment
    • Hospital Psychiatry
    • Geriatric Psychiatry
  • Log In
  • Register
  • Welcome
  • Sign Out
  • Subscribe
Home » Lithium in Geriatric Depression

Lithium in Geriatric Depression

July 3, 2019
Jason Mallo, DO
From The Carlat Psychiatry Report
Issue Links: Learning Objectives | Editorial Information | PDF of Issue
Jason Mallo, DO Dr. Mallo has disclosed that he has no relevant financial or other interests in any commercial companies pertaining to this educational activity.

REVIEW OF: Buspavanich P et al, J ­Affect Disord 2019;251:136–140


TYPE OF STUDY: Prospective, non-randomized controlled trial


Augmentation with lithium has long been established as an effective strategy for refractory depression, but how does it fare in geriatric patients? There is a dearth of evidence on lithium in the geriatric population, which may explain why it is rarely used in older patients. In this multicenter, prospective, non-randomized controlled trial, investigators evaluated the effectiveness of lithium augmentation in geriatric vs non-geriatric patients with major depressive disorder.


The study enrolled 226 patients with moderate to severe major depression (non-bipolar) who had failed at least one antidepressant trial. Lithium was added to their current antidepressant, and those who received at least 4 weeks of lithium were analyzed for response (n = 167), which was defined as ≥ 50% reduction on the Hamilton Depression Rating Scale. These patients were followed for 7–8 weeks. Responses were compared in geriatric (age ≥ 65) and adult patients.


Of the 167 patients analyzed, 22 were geriatric and 145 non-geriatric. The proportion of patients who completed the study was similar in both groups, as were other variables except age of onset, which was higher in the geriatric group. Most patients were female and had been in their current episode for 3 to 12 months. Both groups had similar mean lithium levels at the end of the study (0.61 for geriatric patients and 0.69 for non-geriatric).


Interestingly, geriatric patients had a significantly greater and more rapid response to lithium augmentation than those under age 65 (p = 0.04). Clinical response was 68.2% for geriatric patients and 46.9% for non-geriatric. The authors proposed these differences could be explained by age-related changes in pharmacokinetics and pharmacodynamics. For instance, decline in integrity of the blood-brain barrier with age may allow for quick and sufficient lithium levels. Additionally, lithium has neuroprotective effects, and neurodegenerative processes may play more of a role in the pathophysiology of depression in geriatrics.


While the authors claimed safety and tolerability were implied by the number of patients completing the study, the lack of data on adverse outcomes was a weakness. Plus, the sample size of geriatric patients was small, at least relative to non-geriatric patients. Another weakness was the lack of a non-lithium control group, making it difficult to establish whether these outcomes were unique to lithium.


TCPR’S TAKE
Geriatric patients are usually less responsive to antidepressant therapies than younger cohorts, so these results are a surprise. They lend further support to lithium augmentation in refractory depression. However, older patients are more at risk for adverse effects, drug interactions, and medical problems with lithium. Those risks need to be weighed against the risk of continued depression, which takes a toll on physical as well as mental health.



For more on this subject, listen to our podcast, “Lithium’s Health Benefits”


General Psychiatry
KEYWORDS depression depressive_disorder geriatric-psychiatry lithium psychopharmacology treatment-resistant-depression
    Jason Mallo, DO

    Hypothyroidism and Depression: Just How Related Are They?

    More from this author
    www.thecarlatreport.com
    Issue Date: July 3, 2019
    SUBSCRIBE NOW
    Table Of Contents
    CME Post-Test - Side Effects Part I, TCPR, June/July 2019
    Mood Stabilizers and Stroke Risk in Bipolar Disorder
    Lithium in Geriatric Depression
    New Augmentation Strategies in OCD
    Esketamine Gets FDA Approval
    Risk Evaluation and Mitigation Strategy (REMS) Programs
    Medication Side Effects: Nausea, Sweating, and Dry Mouth
    Are Auditory Hallucinations Ever Normal?
    Brexanolone (Zulresso) for Postpartum Depression
    A New Dopamine and Norepinephrine Reuptake Inhibitor for Excessive Sleepiness
    A New Proposal for SSRI Withdrawal
    SSRI withdrawal symptoms
    DOWNLOAD NOW
    Featured Book
    • MFB6eCover.jpg

      Medication Fact Book for Psychiatric Practice, Sixth Edition (2022)

      Guidance, clinical pearls, and bottom-line assessments covering the medications you use in your...
      READ MORE
    Featured Video
    • therapist_canstockphoto9201097.jpg
      General Psychiatry

      Using SAMe In Clinical Practice with Garrett Rossi, MD

      Read More
    Featured Podcast
    • canstockphoto22709844.jpg
      General Psychiatry

      Psychopharm Commandment #10: Don’t Fear these Meds

      Surprising health benefits of our riskiest meds: Lithium, quetiapine, and clozapine.

      Listen now
    Recommended
    • Approaches to Autism Intervention

      January 31, 2022
      canstockphoto2240982_child-bubbles_thumb.jpg
    • Currently Available Cannabis Products

      September 1, 2022
    • Interpreting Assessment Discrepancies from Multiple Sources

      October 17, 2022
      ChildAssessment.png
    • Approaches to Autism Intervention

      January 31, 2022
      canstockphoto2240982_child-bubbles_thumb.jpg
    • Currently Available Cannabis Products

      September 1, 2022
    • Interpreting Assessment Discrepancies from Multiple Sources

      October 17, 2022
      ChildAssessment.png
    • Approaches to Autism Intervention

      January 31, 2022
      canstockphoto2240982_child-bubbles_thumb.jpg
    • Currently Available Cannabis Products

      September 1, 2022
    • Interpreting Assessment Discrepancies from Multiple Sources

      October 17, 2022
      ChildAssessment.png

    About

    • About Us
    • CME Center
    • FAQ
    • Contact Us

    Shop Online

    • Newsletters
    • Multimedia Subscriptions
    • Books
    • eBooks
    • ABPN Self-Assessment Courses

    Newsletters

    • The Carlat Psychiatry Report
    • The Carlat Child Psychiatry Report
    • The Carlat Addiction Treatment Report
    • The Carlat Hospital Psychiatry Report
    • The Carlat Geriatric Psychiatry Report

    Contact

    info@thecarlatreport.com

    866-348-9279

    PO Box 626, Newburyport MA 01950

    Follow Us

    Please see our Terms and Conditions, Privacy Policy, Subscription Agreement, Use of Cookies, and Hardware/Software Requirements to view our website.

    © 2023 Carlat Publishing, LLC and Affiliates, All Rights Reserved.